What does a lung transplant cost in South Africa?

Lung transplants became a topic of intense media interest when, in 2021, South Africa’s first Covid-related lung transplant was necessitated, and successfully conducted.

However, there are many other conditions that warrant lung transplantation. Research indicates that the most common diseases leading to a lung transplant are chronic obstructive pulmonary disease (COPD), interstitial lung disease, cystic fibrosis, alpha-1-antitrypsin deficiency and pulmonary arterial hypertension.

This article outlines the cost of transplantation and related medical expenses, and the waiting time involved when a lung transplant is needed.

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How common are lung transplants?

Lung transplants are rare procedures for patients with established lung disease, such as cystic fibrosis and other conditions.

“A transplant is done only after all other treatments for lung failure have been ruled out or have proven unsuccessful,” says Mande Toubkin, general manager of emergency, trauma, transplant, disaster management and corporate social investment at Netcare.

Because they are rare, transplants are only performed at Netcare Milpark Hospital in Johannesburg and Groote Schuur Hospital in Cape Town.

Toubkin says the cost of a transplant depends on the overall health of the patient at the time of the transplant, how long a patient has to wait for transplantation, and what has caused their lung disease.

“In the case of cystic fibrosis, there’s a lifetime cost – you have to factor in costs before, during and after the transplant,” she says.

A significant part of the cost is for medication to prevent rejection following the transplant. “This is a lifelong cost, as is the need to care for yourself before and after transplantation,” Toubkin says.

“These costs can be difficult to quantify, and differ from case to case. Costs should also be weighed against the considerable expense of ongoing treatment for a severe illness without the benefit of a transplant.” 

Justine Lacy, clinical executive at Profmed, says that, in Profmed’s experience, the cost can be in the vicinity of R3.3 million for the work-up and transplantation procedure.

The medical examination costs around R350,000, the transplant itself around R2.1 million, and harvesting lungs from a donor around R100,000. “Post-surgery medication for about a year can cost around R775,000,” she says.

The cost difference between a bilateral lung transplant and a unilateral or one-sided transplant is marginal.

Related medical expenses

Lacy says recipients can expect to pay for work-up costs such as bloodwork and additional investigations, donor testing to see if donated lungs are compatible with the needs of the recipient, and hospital extras such as radiology, a bronchoscopy, and appointments with a surgeon, pulmonologist, physiotherapist, perfusionist, anaesthetist and physician.

“Potential recipients should also factor in pre-transplant counselling as well as family education and preparation,” she says.  

Additional costs will include theatre expenses and intensive care for at least a few days after the procedure. “If there are complications post-operatively, hospital costs can escalate rapidly,” Lacy points out.

It's worth asking your medical scheme which costs will be covered, particularly as you will need lifelong treatment after the procedure.

The cost of waiting for a lung donor

You could find yourself in the position of having to wait for suitable lungs, which will mean specialised care for an unspecified period of time. Patients with IPF may have to wait for three to six months, while some patients may have to wait for many years, depending on the severity of their illness and their lung allocation score.

UCT Heart and Lung Centre associate professor Greg Calligaro says there are usually around ten patients waiting for a transplant in Cape Town at any given time, with around ten transplants a year taking place.

Despite the low figure, there is no guarantee of receiving compatible organs. This is because only around 10-15% of lungs referred for transplantation are usable, according to Toubkin.

“Hearts and kidneys are more resilient than lungs and do not have the same high rejection rates,” she says.

“Because of the short lifespan of donor lungs, transplant surgeons follow strict guidelines to transplant the donor organ into the recipient as quickly as possible. Additionally, very few lungs are of good enough quality to meet the strict criteria for transplantation.”

About five out of ten people survive for at least five years after a lung transplant, with many people living for at least ten years – some have even lived for more than 20 years. As such, it is well worth having the procedure – but being on a comprehensive medical plan and having gap cover is a must, to aid transplant recipients with the exorbitant costs.

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